title: Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma.
abstract: OBJECTIVE
  A new risk stratification system was proposed to estimate the risk of recurrence in patients with differentiated thyroid carcinoma (DTC) using the response to initial therapy. Here, we describe the modified dynamic risk stratification system, which takes into consideration the status of serum anti-Tg antibody (TgAb), and validate this system for assessing the risk of recurrence in patients with DTC.
  
  
  METHODS
  Patients who underwent total thyroidectomy with radioiodine remnant ablation due to DTC between 2000 and 2005 were included. We classified patients into four groups based on the response to the initial therapy ('excellent', 'acceptable', 'biochemical incomplete', and 'structural incomplete' response).
  
  
  RESULTS
  The median follow-up period of 715 patients with DTC was 8 years. The response to initial therapy was an important risk predictor for recurrent/persistent DTC. The relative risks (95% CI) of recurrence were 16.5 (6.3-43.0) in the 'acceptable response' group, 41.3 (15.4-110.8) in the 'biochemical incomplete response' group, and 281.2 (112.9-700.5) in the 'structural incomplete response' group compared with the 'excellent response' group (P<0.001, P<0.001, and P<0.001 respectively). The disease-free survival rate of the 'excellent response' group to initial therapy was 98.3% whereas that of the 'structural incomplete response' group was only 6.8%.
  
  
  CONCLUSIONS
  Our study validates the usefulness of the modified dynamic risk stratification system including the status of serum TgAb for predicting recurrent/persistent disease in patients with DTC. Personalized risk assessment using the response to initial therapy could be useful for the follow-up and management of patients with DTC.
authors.affiliation: Departments of Internal Medicine.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Jeon
authors.forename: Won Gu
authors.initials: WG
authors.lastname: Kim
authors.forename: Woo Ri
authors.initials: WR
authors.lastname: Park
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Han
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Kim
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Song
authors.forename: Ki-Wook
authors.initials: KW
authors.lastname: Chung
authors.forename: Jin-Sook
authors.initials: JS
authors.lastname: Ryu
authors.forename: Suck Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Young Kee
authors.initials: YK
authors.lastname: Shong
authors.forename: Won Bae
authors.initials: WB
authors.lastname: Kim
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D002277:Carcinoma / Q000175:diagnosis / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D057285:Precision Medicine / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D055502:Secondary Prevention; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy
chemical_list: D001323:Autoantibodies; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; C006606:anti-thyroglobulin